Did you know: Home birth is as safe as hospital birth?

I’ll just say that again in case you didn’t read the title properly or you thought it was a misprint! Home birth is as safe as hospital birth. In fact some studies have shown home birth to actually be safer than hospital birth.

Of course there are caveats, and here are some of them. Firstly, you need to be identified as a low risk mother. This means when you are assessed you do not have any on-going health complications, you do not have any unusual gynecological problems and that your baby is also well (and a singleton). Second, you need to receive professional care from a midwife during you pregnancy, labour, birth and afterwards. Thirdly, you need to have access to a maternity unit should your risk status change during your pregnancy or labour.

How can this be, I hear you ask?

Isn´t hospital the safest place in the world to have a baby? Isn´t that where the experts are? Isn’t that where all the machines, theatres and the resuscitation equipment is? Isn’t that where all the consultants live? Don’t they know everything? The answer to most of these questions is “no”.

Perceptions of safety and measurement of safety are two quite different things. Our culture perceives that the safest place to have a baby is in hospital, but the research (the measured reality) tells us that home is equally as safe.

What do we mean by safety? Mostly safety is defined by measuring and comparing extreme events in birth. So a base measurement which is quite often quoted in the popular press is the maternal mortality rate, that is the chances of a mother dying whilst pregnant, in labour or up to a year after birth. The chances are based on the number of women that have died in recent years. Another rate is the perinatal mortality rate, which are the chances of a baby dying during or following birth and it is calculated in the same way.

There are very few measures of the “health and well being” of a mother and baby following birth and I am not talking agpar scores here. I am talking about whether the mother (and baby) has come through the process without injury either physically or emotionally. For example, that the mother did not have infected scars, did not have a bleed after the baby was born, did not have to have her placenta removed manually did not have excessive tears, did not contract MRSA, and did not have PND.

Whichever way you look at it whether it’s by measuring extreme events or health and well being home birth comes off no worse than hospital birth, in fact many studies show that the chances of having interventions (which always places higher risks to safety of the mother and baby) are much lower at home.

Part of the reason for this people say is that hospitals do not just cater to low risk women, but also to high risk women and babies. None the less when this bias is statistically factored out home birth still comes off no worse than hospital birth.

Here are some studies from the British Medical Journal that looked at safety of home birth

“Low risk women in primary care with planned home birth at the onset of labour had a lower rate of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. These differences were statistically significant for parous women.”

“Generally, births planned to take place at home, in hospital and in midwife units all carried a low level of risk.

However, when the researchers focused solely on women planning to have their first baby at home, they found they were almost three times more likely to suffer complications than if they went to hospital. It’s important to note, however, that even this elevated risk equated to a low chance of serious complications and only related to minor complications.”

“Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”

So if that is what the science says why do we as a society think home birth is so unsafe? How did we come to believe this, that home birth is less safe than hospital birth? I am speculating here but these are my suspicions:

Lack of information. People conjure up a notion of home birth that doesn´t include the very specialised care of a professional midwife. They think that home birth means getting no medical care at all, which sounds unsafe and reckless.

Dodgy historical associations. People think back to how home births happened in the last century, when women had no access to birth control and had many babies in a short period of time, when women had minimal access to medical care during pregnancy, often lived in unsanitary crowded conditions, were poorly nourished and had to return to household duties very soon after they gave birth. This period of time was associated with poorer birth outcomes for mother and baby. By the 1970s the vast majority of Irish women were giving birth in hospitals. By the 1970s outcomes for mother and baby had improved, and so a direct correlation was made between increasing hospitalisation and improved outcome. However, other things had also changed during the same time period for example, nutrition, living conditions and access to free good quality antenatal care, and in fact it was these factors rather than the move to hospital that was responsible for improved outcomes.

Imposing hospital scenarios on home birth settings. We are bombarded by frightening images of screaming women and harried staff on TV and media rushing to control this scary process of birth. ER type scenarios abound and the result is that the collective consciousness views birth as being full of unpredictable dangerous possibilities. How can these possibly be catered for at home? By the looks of things they are only just about managed in hospital with people trained to deal with this type of thing! First of all lets rule out the high risk cases that hospitals have to deal with that will never see the dimmed light of your living room. Then there is the issue of interventions that in many cases alter the way a labour would naturally progress and by its very nature introduces an increased element of risk. These interventions don’t happen at home. Finally remember at home you are cared for by a midwife who is trained to view birth as normal. In hospital, most women are under the supervision of obstetricians who are trained to deal with the abnormal and who tend to only view birth as normal in hindsight. These two approaches alone often result in different approaches to labour. Also remember that women opting for a home birth are constantly screened and reassessed by their care provider and should anything unusual arise during the pregnancy labour birth or beyond the women will be transferred to obstetric care.

The “what if” scenario. People often say to me “What if something goes wrong?” I then ask “Such as?” and mostly people don’t know exactly what they are referring to. It’s the unnamed “something”, the unnamed fear that often propels pregnant women and their families into taking decisions they wouldn’t normally be comfortable with. For most people the “what if” comes down to something happening to the mother or something happening to the baby. To the mother the common concern is post partum hemorrhage, well if that happens at home the midwife will give the appropriate drugs to stop the hemorrhage and may set up a drip and arrange transport to hospital. To the baby the common concern is baby not breathing. All midwives are trained in the exact same neonatal resuscitation techniques as their counterparts in hospital and have to maintain their certification in this area. Midwives carry oxygen and bagging equipment that help inflate baby´s lungs. If the baby requires transfer to hospital for observation this will be arranged.

Now don´t get me wrong here I am not saying that home birth carries no risk, all birth as life itself carries risk. What is important is to evaluate the risk and make your decision. The science tells us that the risk of adverse outcomes at home is no worse than that found in hospital. For most people, the difficulty arises in actually believing the science and letting go of their long standing beliefs or commonly held beliefs.